Before a Facelift Surgery

Do I need to meet with a general doctor before the surgery? To save money. It’s not a large amount, but why not do the necessary tests at the expense of the health fund? Before a facelift, a general physical examination is required. If there are no special issues, it’s enough for the plastic surgeon and the anesthesiologist to examine you. Additionally, blood tests (blood count, biochemistry, bleeding time, and clotting) are needed, and if you are over 45, you will also need a chest X-ray and an ECG. You can ask your family doctor for these. It’s important to inform the surgeon and anesthesiologist about any tendency to bleed, high blood pressure, diabetes, liver and kidney diseases, severe spinal issues, immune system problems, previous issues with local or general anesthesia, heart diseases, and arrhythmias. These are all important factors in the anesthesiologist and surgeon’s decision-making.

What should be done before the surgery? It’s important to stop taking aspirin or other substances containing salicylic acid (salicylic acid). These include pills such as: Cardia, Microprin, Ronal, Alka-Seltzer, Advil (which contains aspirin), and others. It’s important to stop taking these pills at least two weeks before the surgery. Why? Because this substance, salicylic acid, prevents blood from clotting properly and increases the tendency to bleed. This is why these pills are useful for treating heart attacks, but not before a facelift. For the same reason, it’s also advisable to stop taking Vitamin E. While it’s an antioxidant and generally good for the skin, it also increases the tendency to bleed.

———–

Pre-surgery tips:

• Dye your hair. Not specifically for the surgery, but if you dye your hair regularly, this is the time to “touch up” your roots because you won’t be able to do it for four to six weeks afterward.
• Prepare clothes that you don’t need to pull over your head, including nightgowns and t-shirts (unless they have a V-neck). After the surgery, your head will be bandaged, and even when the bandages are removed, it’s better not to move, twist, or touch your head unless necessary.

What about smoking? You should also stop smoking. This is true in general, and especially before plastic surgery. Nicotine constricts blood vessels, and during and after the surgery, when the skin is stretched, it requires a good blood supply. Nicotine, which constricts blood vessels and impedes blood flow, increases the risk of skin necrosis. If that’s not enough, carbon monoxide from smoking binds to red blood cells, reducing blood flow to tissues. Therefore, even if you can’t or don’t intend to quit smoking completely, it’s crucial that you stop smoking about 10 days before the surgery and 7 days after.

What should you do on the day of the surgery itself?

• Wash your hair once or twice.
• Don’t apply cream or makeup on your face.
• Fast for about 6 hours before the surgery, including no drinking.

After Facelift Surgery

How do you look immediately after the surgery? Not great. Unlike cosmetic treatments, where you look your best immediately after the treatment, after plastic surgery, the look you see in the mirror right after is far from flattering. However, remember that cosmetic treatments offer short-term results, while the results of a facelift last for many years. When you wake up from the anesthesia, you will find your head bandaged like a “babushka,” with a bandage wrapping your face around the forehead, cheeks, and jawline. In most cases, the surgeon will also leave two drains (tubes) coming out from behind your ears, one on each side. Their role is to drain excess fluid and blood, and they will remain in place for 24-48 hours. During these hours, you must also maintain the correct position while lying down: the upper half of your body should be elevated. To avoid bending your neck, your head should stay raised. This posture is meant to prevent fluid buildup in the face.

Are there any pains at this stage? No, not really. It’s not painful at all. In fact, the appearance of pain is a warning sign that may indicate sudden bleeding or infection. If this happens, pain will appear on only one side of your face, and you should immediately notify your doctor.

Do you really not feel anything? You won’t feel pain. However, you may feel a slight pressure (choking) sensation in the neck due to the stretching of the neck muscles. To avoid panicking, remember that it’s just a sensation. It’s uncomfortable, but you’re not really choking. This feeling can last up to two weeks. After that, two things happen to alleviate it: you get used to it, and the muscle relaxes a bit.

When can you get out of bed? As soon as possible. A few hours after the surgery, and assuming you no longer feel dizzy, nauseous, etc., it’s very important to get out of bed. Why? To get the blood circulation going, which helps prevent unnecessary complications like blood clots in the legs. If this is true after heart surgery, it’s certainly true and recommended after a facelift as well.

How do you look after the bandages are removed? Still not great. Your face will be swollen, especially in the areas that were operated on. It will appear too tight, and there will be bruises, especially in the neck area. And that’s not all: in the next few days, your face will swell even more.

Why does the face swell? This is due to the normal inflammatory process, which is part of the healing process. The body, which underwent significant trauma during the surgery, works to protect itself by increasing blood flow and mobilizing white blood cells and other components to help the body heal. The increase in white blood cells causes what we call inflammation, but this is a normal inflammation, not an infection. It’s a natural process that helps the body repair itself. During this process, there are more fluids in the body, increased blood flow, and what you see is more swelling. The swelling peaks on the third day after the surgery, and then improvement begins gradually. The swelling will decrease from the cheeks toward the upper neck area, and over the next few weeks, it will disappear entirely. One more thing about swelling: it may have some apparent benefits. During the period when your face is still swollen, it may look as if you’ve had a facial peel—without any wrinkles, even the fine ones. These fine wrinkles will reappear as the swelling goes down. The dramatic change in your appearance will remain, as will the shift to a younger face shape. The fine wrinkles will return eventually.

——— The swelling and bruising after surgery can be minimized using biological glue during the surgery, or by a new product called PRP (Platelet Rich Plasma), which is a mixture of biological glue and blood platelets (thrombocytes), sprayed under the skin before the surgery ends. Another option is Arnica Montana, given as pills before and after the surgery.

———

When are stitches removed? Stitches are typically removed about 7 days after the surgery.

Is it allowed to shower and wash your hair after a facelift? Yes, absolutely. In fact, it’s advisable to wash your hair daily after the surgery. As a rule, you should know that scars heal better in a clean environment, not one with dirt and discharge. Therefore, most surgical incisions should be cleaned with water and soap.

When can you start wearing makeup? Two to three days after the surgery, you can use makeup, but not on the stitches. Make sure to use makeup that is easy to remove and doesn’t require excessive rubbing.

———

Post-surgery tips:

• Do not wear anything over your head during the first three weeks after the surgery. No turtlenecks, sweatshirts, t-shirts, or anything else you need to pull over your head. Why? To avoid accidentally damaging the stitches behind your ears and to prevent unnecessary complications.

• Don’t wear earrings for six weeks, as you could tear your earlobes easily (sometimes you won’t even feel it), and because there’s tension behind your ears due to the stitches.

• Don’t chew gum for two weeks. Yes, even if it sounds silly. Chewing motions can add tension to the stitches behind your ears and interfere with the healing process.

———

What is the connection between lymphatic massage and a facelift? Before we talk about the connection, let’s explain what lymphatic massage is. The lymphatic vessels are delicate tubes found all over the skin, and their job is to drain interstitial fluid. This fluid is transferred to larger vessels, then to local lymph nodes, and eventually to the bloodstream. During surgery, lymphatic vessels can get damaged. While these vessels have regenerative qualities (like a chameleon’s tail), fluids can accumulate in the body and cause swelling. We want to reduce this swelling, and we can do so by stimulating the healthy lymphatic vessels, which can be done through lymphatic massage. This type of massage should be performed by skilled professionals. Unlike regular massage, which targets muscles, lymphatic massage is more gentle and is performed according to the direction of lymph flow.

How is this connected to a facelift? After the stitches are removed, lymphatic massages can be performed to help reduce the swelling more quickly.

When can you return to work? About one to two weeks after surgery, you can gradually return to normal activities, depending on the effort required in your work. Physical activities (like carrying heavy boxes) should be delayed for another month.

Facelift Questions
How Do You Know What You Want?
As usual, it depends on what’s bothering you:

• If what bothers you are spots and fine wrinkles, the solution you’re probably looking for is a peel.
• If what bothers you is sagging of the upper eyelid, excess skin on the upper eyelid, the formation of folds, and the inability to apply makeup, look for the solution in a brow and/or upper eyelid lift surgery.
• If what bothers you is “hollow” or “sagging” cheeks, you can fill them with a facelift combined with a mid-face lift, or by injecting fillers or silicone implants.
• If you’re bothered by wrinkles around the mouth, thinning lips, and deep lines between the nose and mouth, you should consider a peel, filler injections, or a combination of the two.
  In all of these cases, the solution to your concern is not a facelift.

Do You Want a Facelift?
Place your hands under your ears, and gently stretch your neck skin upwards and slightly backwards.
If your neck skin tightens and the appearance of your jawline improves, and that makes you happy, you probably need a neck lift.
Now, lie on your back and look in the mirror. Does the appearance of your cheeks improve dramatically (compared to when you’re standing)? This is the closest simulation of what a facelift can do, although with a facelift, your face will also be slightly lifted, which lying on your back doesn’t do.
What if you have excess neck fat, or in other words: a “double chin”? This double chin (which sometimes appears triangular or square) can disappear with a combination of a facelift and liposuction from the neck. Liposuction from the neck alone is possible but not always recommended, depending on the amount of excess skin and the condition of the neck muscles. In many cases, just tightening the neck skin can cause folds of excess skin between the ear and cheek.

Did You Know?
During a facelift, only the neck muscles are tightened. The facial muscles are not touched at all.

Complications in Facelift Surgery

• Bleeding – Subcutaneous bruising, which appears as typical blue marks after a facelift, is not considered a complication. However, accumulated blood under the skin can cause not only pain but also skin necrosis, so it’s important to drain this blood promptly.
  This type of bleeding is sharp and must be checked in the first days after the surgery. The drainage is done by opening the surgical incision, sucking out the blood, and cauterizing the bleeding blood vessels.
  It’s also important to know that this complication is more common in people with high blood pressure, so it’s crucial to regulate blood pressure before and after surgery.
• Infection – Infections are extremely rare in facelifts. The infection manifests as local pain, redness in the area, and sometimes pus discharge from the sutures. Treatment for infection includes antibiotics and/or surgical drainage.
• Asymmetry – Immediately after surgery, when the face is swollen, there may be asymmetry due to uneven swelling of both sides of the face.
  In most cases, this asymmetry balances out as the healing process progresses, so it’s important that the final check-up takes place after a few months. However, it’s important to remember that, like the rest of the body, our faces are not symmetrical, and what wasn’t symmetrical before the surgery will not be symmetrical after. Furthermore, because of the asymmetric actions of the facial muscles, facial asymmetry increases over the years. Many complaints about asymmetry arise after surgery, especially during the recovery period, when there’s a natural tendency to examine the face as if it were under a magnifying glass.
  On the other hand, there are definitely cases of asymmetry that are a complication of the facelift. This asymmetry didn’t exist before, and it was caused by improper tightening. To fix such a complication, corrective surgery is required.
• Skin Necrosis – The appearance of non-healing sores. This is a relatively rare, but unpleasant, complication, especially in smokers.
  Necrosis typically appears behind the ear and is usually treated conservatively. This means the wound heals by itself (as it knows how to), but to prevent secondary infection, it is treated with ointments and bandages.
  Sometimes, a scar remains after the necrosis heals, and it tends to improve over time. If necessary, it can be removed in a corrective surgery, but only after a few months.
• Pain – This is an extremely rare complication. It’s not the sharp pain typical of bleeding or infection, but a dull, chronic pain.
  Such pain can occur in the area of the surgical scar or nearby, and it happens because of damage to a small sensory nerve. These pains can be treated with steroid injections or with local massages aimed at raising the pain threshold of the nerve and “teaching” it to react differently to pain stimuli.
• Nerve Damage – During the surgery, branches of the facial nerve (the seventh nerve) that control the facial muscles may be damaged.
  There are two nerve branches that may be affected:
• The branch that controls the muscle that raises the eyebrow – if damaged, you will not be able to raise the affected eyebrow.
• The branch that controls the muscle that lowers the lower lip – if damaged, the two parts of the lower lip will not lower symmetrically. This is not a distortion of the mouth angle but of part of the lower lip.
  In both cases, the damage is usually temporary and resolves within a few weeks.
  In a small percentage (0.1%) of cases, the damage may be permanent. In such cases, the situation can be improved by eyebrow lifting surgery and physiotherapy for the lip area.

When to Call Your Doctor?

• If, for some reason, you weren’t under supervision and the night after surgery you’re suffering from nausea. You don’t want to vomit, and only your doctor can provide something to help.
• If you feel sudden or persistent pain.
• If one side of your face or neck starts swelling disproportionately to the other side, especially if this happens in the first 2-3 days after surgery or between days 8-10.
• If the area around the incisions fills with pus or appears infected.
• If the stitches begin to open.

Warning About Late Bleeding
Severe bleeding – although rare – can occur between the 8th and 10th day after surgery. This bleeding originates from a small subcutaneous artery that runs in front of the ear and continues to the temple area.
The bleeding is usually caused by an increase in blood pressure due to physical activity, prolonged bending, taking aspirin or vitamin E, or even from vigorous sexual activity.
If this happens to you, press the area in front of the ear or above it, call an ambulance, and contact your doctor immediately.